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INVENTORY
REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA 1
COUNTY OF Cumberland f SS File Number 21-12-0190
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Personal Representative(s) of the Estate of Janet D. Lassi
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of the inventory.
I verify that the statements made in this Inven- c o ~ t~ C)
tory are true and correct. I understand that false state- r~
ments herein are made subject to the penalties of v r- nr rrl
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18 Pa.C.S. § 4904 relating to unworn falsification to ;
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authorities. ~ - ca
Attorney (Name)
(Supr~Qe~urt I Lqb )1- " i
(Address) n
(Telephone)
DATE OF DEATH LAST RESIDENCE
DECEDENTS SOC. SEC. NO.
02/04/2012 306 April Drive, Camp Hill, PA 17011 124-22-6345
FIGURES MUST BE TOTALED
Real Estate--306 April Drive, Camp Hill, PA 17011 142,000.00
1994 Ford Crown Victoria Sedan
1,900.00
Erie Insurance--reimbursement of auto insurance premium
440.00
U.S. Treasury--Federal Income Tax refund for 2011
Furniture 245.00
425.00
Dryer and Washing Machine
425.00
Verizon--refund
Cash 7.99
25.00
Pa. Treasury, Dept. of Revenue--Property Tax Refund for 2011 250.00
Erie Insurance--Reimbursement of homeowners' insurance premium
61.50
Credit on Settlement Sheet for Sewer bill
Television 60.98
100.00
1/3 CT. Diamond Solitaire Engagement Ring, 14 K Gold
649.00
14 K Gold 2 mm Wedding Band
149.00
Credit on Settlement Sheet for County Real Estate Taxes
79.36
Credit on Settlement Sheet for School Real Estate Taxes
1,241.63
(Attach additional sheets as needed)
TOTAL: 148,059.46
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b))
Form RW-09 rev. 10. 13.06